Monday, January 17, 2005
Today's New York Times provides a detailed overview of the recent dispute between Eli Lilly and Company, a large pharmaceutical company that manufactures Prozac as well as several other well-known drugs, and the British Medical Journal, one of the leading medical journals, which publilshes not only medical studies but also news. In early January, the Journal reported that Lilly did not dislcose certain studies about Prozac before the FDA back in the late 1980s when it was seeking approval for the drug. Lilly responded quickly by rebutting the alleged non-disclosures point-by-point. Now, the ball is back in the British Medical Journal's court and it does not appear that they are ready to back off their story. It is unclear who is correct, but it should be interesting to follow and see who is correct about the disclosure of the information. [bm]
Sunday, January 16, 2005
The AMA prohibits physicians from direct participation in administering the death penalty. (See Ethics Op. E-2.06.) So, when Kentucky governor Ernie Fletcher, M.D., signed the death warrant on inmate Thomas Clyde Bowling, did he violate this tenet of medical ethics? Four Kentucky inmates petitioned the state's Board of Medical Licensure for an answer to that question. The Jan. 13 Louisville Courier-Journal reports that the medical board
decided that Gov. Ernie Fletcher did not violate medical ethics by ordering the execution of a death row inmate.
With no public discussion, a state Medical Licensure Board committee unanimously agreed that Fletcher, a physician, did not violate guidelines that bar doctors from participating in executions.
The committee, which examined the issue at the request of four death-penalty opponents, said Fletcher was acting as governor, not as a doctor, when he signed a Nov. 8 death warrant for Thomas Clyde Bowling.
Although it is probably politically predictable, the board's decision takes a curiously legalistic slant on this ethical problem.
But medical ethics experts questioned whether a doctor who becomes a governor can separate his two roles.
"I would hold the view that as long as he continues to call himself a physician, he's bound to the ethics of that position," said Dr. Clarence Braddock, a professor of medicine at Stanford University.
Paul Lombardo, a law and medical ethics professor at the University of Virginia, said drafters of the AMA guidelines probably meant to ban physicians from activities such as administering drugs during an execution by injection.
"I don't believe the medical association rules generated to stand in the way of physician participation in an execution really contemplated this situation," he said.
That may be, but the text of the AMA's prohibition on physician participation is quite broad:
Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner.
It isn't much of a stretch to equate the governor's signing of a death warrant with (3), would it? [tm]
The New York Times reports today that Newt Gingrich has made reforming the American medical system one of his top priorities. Although he has been out-of-office and out of the public eye for awhile, Newt is now making his presence felt once again. I don't agree with many of his ideas but it is good to have a conservative talking about health care without focusing exclusively on tort reform. Newt wishes to decrease medical error through the use of information technology (less errors due to handwriting misreads) and better reporting requirements. Borth are fairly non-controversial ideas that most people would agree about their benefits. He is also a big fan of health care savings accounts (I am not). The article is an interesting read and I recommend it for those desiring to learn about potential reforms that may be suggested to Congress in the near future. [bm]